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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 1  |  Page : 48-54

The knowledge, acceptance, and practice of exclusive breastfeeding among caregivers seen in a pediatric outpatient department and immunization clinic


Department of Paediatrics, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria

Date of Submission01-Apr-2020
Date of Decision20-Jun-2020
Date of Acceptance08-Jul-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Abdulsalam Mohammed
Department of Paediatrics, Kano/Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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DOI: 10.4103/smj.smj_28_20

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  Abstract 


Background: Feeding a newborn infant with his or her mother's breast milk only or from a wet nurse without giving other liquids up to the age of 6 months is called exclusive breastfeeding (EBF). The promotion of EBF for the first 6 months of infant's life is the most effective way to reduce morbidity and mortality, especially in low- and medium-income countries. Despite several efforts to promote EBF, its practice has remained poor in many Sub-Saharan African countries including Nigeria. EBF practice is to a large extent influenced by the maternal knowledge and attitudes as well as sociodemographic and cultural factors. Objective: To determine the knowledge, acceptance, and practice of EBF among caregivers in Aminu Kano Teaching Hospital, Kano, Nigeria. Methods: This was a cross-sectional, descriptive study involving mothers who were currently breastfeeding at the time of the study or who had stopped breastfeeding not later than 2 years. Questionnaires were administered to breastfeeding mothers or fathers who knew the breastfeeding attitude of their wives during visits to the outpatient unit or immunization clinic. The age, sex, educational status, occupation, awareness, understanding of EBF, acceptance, practice, and benefits of EBF, and distance from health facility were explored from the caregivers. Results: Two hundred and seventy caregivers were studied of which 30 (11.1%) were male and 240 (88.9%) were female. The male-to-female ratio was 1:8 and the age ranges from 19 to 60 years with a mean of 29.4 and standard deviation of ±7.36. Majority of the caregivers (134, 49.6%) had tertiary level of education, while 79 (29.3%) had secondary education. Majority of the caregivers had good awareness and perception of EBF (77% and 51.5%, respectively). The EBF practice rate among the respondents was 68.52%. Caregivers with tertiary and secondary levels of education had good awareness and perception of EBF (χ2 = 48.628, P = 0.000; and χ2 = 49.106, P = 0.000, respectively). They also had good acceptance and practice of EBF (χ2 = 35.897, P = 0.000; and (χ2 = 17.999, P = 0.001, respectively). There were more awareness and perception of EBF among health workers and teachers (χ2 = 33.972, P = 0.000; and (χ2 = 12.925, P = 0.005, respectively). They also accepted and practiced EBF significantly (χ2 = 16.867, P = 0.001; and χ2 = 16.736, P = 0.001). Proximity to health facility had a significant impact on awareness, acceptance, and practice of EBF by the caregivers (χ2 = 17.391, P = 0.002; χ2 = 14.263, P = 0.007; and χ2 = 9.802, P = 0.044, respectively). Conclusion: Educational level, occupation, and proximity to health facility have positive impact on awareness, perception, acceptance, and practice of EBF among caregivers in Kano. Therefore, there is need to educate and empower women and make health facilities accessible to them to support, promote, and protect EBF in our communities.

Keywords: Breastfeeding, exclusive breastfeeding, infants, practice


How to cite this article:
Mohammed A, Aliyu I. The knowledge, acceptance, and practice of exclusive breastfeeding among caregivers seen in a pediatric outpatient department and immunization clinic. Sahel Med J 2021;24:48-54

How to cite this URL:
Mohammed A, Aliyu I. The knowledge, acceptance, and practice of exclusive breastfeeding among caregivers seen in a pediatric outpatient department and immunization clinic. Sahel Med J [serial online] 2021 [cited 2021 Apr 22];24:48-54. Available from: https://www.smjonline.org/text.asp?2021/24/1/48/312737




  Introduction Top


Breastfeeding remains the simplest, healthiest, and least expensive feeding method for virtually all infants.[1] The prevalence of exclusive breastfeeding (EBF) for the first 6 months of life has remained low worldwide.[2] EBF is defined by the WHO as the administration of only breast milk to the infant from his or her mother or a wet nurse, or expressed breast milk and no other liquids or solids, for the first 6 months of life, with the exception of drops or syrups consisting of vitamins, minerals supplements, or medicines.[3] EBF is a term used to define the process by which only breast milk is offered to the new born till the first 6 months of life.[3] About 823,000 deaths of children under 5 years could be prevented every year through optimal breastfeeding practices.[4] Optimal breastfeeding practices reduce hospitalization among children from diarrhea, respiratory infections, and otitis media illnesses.[4]

Nutrition is important for all species to live, survive, sustain, as well as essential to grow, develop, and lead a productive life.[2] The word “nutrition” has been derived from the word “nutricus” which means to “suckle at breast.” During pregnancy, the placenta is the main source of nutrition to the growing fetus.[5] After delivery, one of the first gifts received by a baby is from the mother which is a promise by her to her baby to provide everything needed for this little baby.[3] Nutrition to the baby is an important and effective link which will cater to many issues such as malnutrition, mortality, and morbidities, which may have debilitating effects not only on the individual but also on the society as a whole.[5]

Breastfeeding confers both the short- and the long-term benefits to both the infant and the mother.[5] One of the important functions which early initiation of breastfeeding does is an early skin-to-skin contact between the mother and the new born, which is very important in reducing the occurrence of hypothermia in the baby and also helps in establishing the bond between the mother and her child.[5],[6],[7],[8] Other benefits of breastfeeding include protecting infants against acute and chronic disease conditions and thus help in the reduction of infant morbidity and mortality.[8]

Studies have shown that cases of diarrhea and pneumonia which are two of the most important causes of neonatal and infant mortality are more common and severe in children who are artificially fed.[8] Breastfeeding plays an important role in proper and better cognitive development of the infant. [1],[2]

Studies have documented a positive association between breastfeeding and the intelligence among children aged between 7 and 13 years.[6] Further study reported that the duration of breastfeeding had an inverse relationship with the age at which the child started walking.[5] For the mother, it has also been observed that early initiation of breastfeeding reduces the mother's risk of postpartum hemorrhage, which is one of the leading causes of maternal mortality.[5] Mothers who exclusively breastfed their infants had less than a 2% risk of becoming pregnant again in the first 6 months postpartum and this helps in child spacing. [5],[6] For almost all infants, breastfeeding remains the simplest, healthiest, and least expensive feeding method that fulfills the infants' needs.[3] The numerous benefits of breastfeeding are of public health relevance for developing countries as well as for industrialized nations.[9]

Despite strong evidence in support of EBF for the first 6 months of life, its prevalence has remained low worldwide. [9],[10] In Nigeria, breastfeeding is universal with almost all babies being breastfed. However, the practice of EBF is rare with only 17% of children younger than 6 months being exclusively breastfed.[10]

Although several studies have been reported from our study area, these studies were conducted over a decade ago and hence the need for further review of these studies.[7],[8],[9] EBF is influenced by social and cultural attitudes which shape the structural context for breastfeeding.[7] Taking the health systems, healthcare providers influence on the breastfeeding practices; it is seen that the support about the feeding decisions before and after birth and the dissemination of the knowledge and information have been seen to have a greater impact on exclusive and continued breastfeeding.[6],[7],[10] Other factors include high-risk pregnancies, assisted delivery and long hospital stays, maternal illness, and preterm ill, which can further result in breastfeeding starting later. Family support and the practices and experience of female relatives have also been seen to affect the incidence and duration of breastfeeding. [11],[12]

The attitudes and preferences of the fathers were also to affect breastfeeding: those women whose partners were supportive of breastfeeding breastfeed for longer. Further, women's work is one of the leading motives for not breastfeeding or for early weaning. Its effect is multidimensional, which may include fatigue and practicality.[12],[13],[14],[15],[16]


  Methods Top


This was a cross-sectional, descriptive study involving mothers who are currently breastfeeding at the time of the study or who had stopped breastfeeding not later than 2 years. Data were collected using a comprehensive, pretested, structured interviewer-administered questionnaire which sought information such as age, sex, educational status, occupation, awareness, understanding of EBF, acceptance, practice, and benefits of EBF, and distance from health facility, which was explored from the caregivers. Ethical approval was given by the Ethics Committee of Aminu Kano Teaching Hospital. Verbal informed consent was obtained from study subjects in their own language explaining the purpose of the study and the right to withdraw from it. The respondents were also assured of confidentiality. EBF in this study refers to the practice of giving the infant only breast milk for 6 months without any fluids, except liquid medicines. Awareness of EBF means being informed of the existence and practice of EBF. Perception (understanding) of EBF is the knowledge of the complete definition of EBF. Acceptance of EBF here means agreeing/believing with EBF and being ready to practice it. Practicing EBF is the full implementation of the act of EBF as outlined by the WHO. Benefits of EBF refer to the advantages of EBF to the baby.

Quantitative data were coded, entered, and analyzed using Statistical Package for the Social Sciences (SPSS) Version 20.0 (IBM Corp, Armonk, NY, USA). Bivariate and multivariate analyses were done to find the factors associated with EBF. P value and Chi-square values were used to test associations. P < 0.05 was considered statistically significant.


  Results Top


Two hundred and seventy caregivers were involved in the study of which 30 (11.1%) were male and 240 (88.9%) were female [Table 1]. The male-to-female ratio was 1:8 and the age range was 19–60 years with a mean of 29.4 and standard deviation of ±7.36.
Table 1: Showing the respondents' variables during the study

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Majority of the caregivers (134, 49.6%) had tertiary level of education, while 79 (29.3%) had secondary level of education. Only 4 (1.5%) had no any form of education. Ninety-one (33.7%) of the caregivers had business as their occupation, while 90 (33.3%) engaged in other forms of occupation such as farming, tailoring, and hair dressing. Forty-five (16.7%) of the caregivers were health workers.

One hundred and forty-nine (51.5%) of the caregivers had 1–3 children and only 6 (2.2%) had more than 10 children. Majority (210, 77.8%) of the caregivers were aware of EBF and 60 (22.2%) were not aware of EBF. One hundred and thirty-nine (51.5%) had good perception of the meaning of EBF, while 131 (48.5%) could not define EBF correctly. Sixty percent of the respondents knew the benefits of EBF correctly while 107 (39.6%) could not mention the benefits of EBF correctly. Majority of the female respondents (87.14%) were aware of EBF, while 27 (90%) male respondents were aware of EBF (χ2 = 2.917, P = 0.063). This is not statistically significant.

One hundred and twenty-two (50.83%) female respondents defined EBF correctly while 17 (56.67%) of the male respondents correctly defined EBF (χ2 = 0.368, P = 0.342). This is not statistically significant. One hundred and ninety-one (79.58%) female respondents accepted EBF while 26 (86.67%) males accepted EBF (χ2 = 0.848, P = 0.257). This shows no statistical significance. One hundred and sixty (66.67%) of the female caregivers practiced EBF, while 25 (83.33%) of the males caregivers accepted and encouraged their spouses to practice EBF (χ2 = 3.434, P = 0.045) and this is statistically significant.

Majority of those with tertiary level of education (123, 91.79%) were aware of EBF. This was followed by those with secondary level of education of which 61 (77.22%) were aware of EBF while 3 (75%) respondents with no any form of education were aware of EBF (χ2 = 48.628, P = 0.000), which is statistically significant. Ninety-five (70.90%) of those with tertiary level of education understood and gave correct meaning of EBF. However, 34 (43.04%) of those with secondary level of education understood and gave correct meaning of EBF. Only 6 (20%) of those with primary level of education could give correct meaning of EBF and only 1 (25%) of those with no education understood the correct meaning of EBF (χ2 = 49.106, P = 0.000). This shows statistical significance.

[Table 2] showed that 122 (91.04%) caregivers with tertiary level of education accepted EBF and 64 (81.01%) of those with secondary level of education accepted EBF. Seventeen (56.67%) caregivers with primary education accepted EBF, 11 (47.82%) caregivers with Quaranic education accepted EBF (χ2 = 35.897, P = 0.000). This is statistically significant. One hundred and two (76.12%) of those caregivers with tertiary level of education practiced EBF whereas 56 (70.88%) of those who had secondary level of education practiced EBF. However, 14 (46.67%) and 10 (43.48%) of those with primary and Quaranic education, respectively, practiced EBF (χ2 = 17.999, P = 0.001). This is statistically significant.
Table 2: Showing the relation between educational level, occupation and proximity to health facility of the respondents to their perception on exclusive breastfeeding

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Forty-five (100%) of the health workers are aware of EBF while 38 (86.36%), 74 (81.32%), and 53 (58.81%) of those who are teachers, business people, and other occupations, respectively, had awareness about EBF practice (χ2 = 33.972, P = 0.000). This is statistically significant. Thirty-one (68.89%) health workers correctly understood the meaning of EBF while 27 (61.36%) of teachers and 46 (50.55%) of those in business, respectively, could give correct meaning of EBF. Only 35 (38.89%) of those doing other jobs correctly defined EBF (χ2 = 12.925, P = 0.005). This shows statistical significance.

Two hundred and seventeen (80.37%) respondents accepted EBF. Forty-three (95.56%) of the health workers accepted and believed in EBF whereas 38 (86.36%) of teachers, 75 (82.42%) of those doing business, and 61 (67.78%) of those doing other jobs believed in and accepted EBF, respectively (χ2 = 16.867, P = 0.001). This is statistically significant. Thirty-seven (82.22%) of the health workers practiced EBF, 35 (79.55%) of teachers, 65 (71.43%) of those in business, and 48 (53.33%) of those doing other jobs practiced EBF, respectively (χ2 = 16.736, P = 0.001) showing statistical significance.

One hundred and eighty-five (85.25%) of the respondents who accepted EBF have been found to be practicing EBF (χ2 = 1.435, P = 0.000). This is statistically significant. Further, among 139 (51.5%) respondents who had good knowledge on EBF, 112 (80.58%) of them practice EBF (χ2 = 19.307, P = 0.000). This is also statistically significant.

Thirty-seven (92.5%) of those living less than 1 km from health facility demonstrated awareness on EBF whereas 20 (64.51%) of those living more than 10 km from health facility showed awareness to EBF (χ2 = 17.391, P = 0.002). Most of the caregivers (87, 32.2%) and 77 (28.5%) lived within a distance of 2–3 and 4–6 km, respectively, from health facility. Thirty-six (90%) of the caregivers who lived less than 1 km from health facility accepted EBF whereas 74 (85.05%) of those living 2–3 km from health facility accepted EBF. Only 18 (56.06%) of the caregivers who lived more than 10 km from health facility accepted EBF (χ2 = 14.263 P = 0.007). This shows statistical significance.

Majority (34, 90%) of those who lived less than 1 km from health facility practiced EBF while 61 (70.11%) of those living 1–3 km from health facility were found to practice EBF. Only 16 (51.61%) of the caregivers who lived more than 10 km from health facility practiced EBF (χ2 = 9.802, P = 0.044). This is statistically significant.


  Discussion Top


The general objective of this study was to find the level of knowledge, acceptance, and practice of EBF among caregivers in Aminu Kano Teaching Hospital, Kano, Northwestern Nigeria. Majority of the caregivers had tertiary level of education; this is against the findings from Ghana[1] where most of the respondents did not have any formal education. The finding in this study is keeping with studies[17],[18],[19] that women with higher level of formal education are more likely to use maternal health and child health services.

The finding in this study, however, is also in keeping with other studies which reported that the level of education of mothers was positively associated with practice of EBF because educated women follow antenatal instruction very well, thereby changing their behavior toward utilization of EBF.[20],[21],[22],[23]

More than half of the study population had good perception of EBF; this is far more than 31% reported by Iliyasu et al. from a local government area in Kano.[24] This may be attributed to the level of education of the respondents in this study when compared to earlier study from Kano which was a community-based survey involving mothers from the core communities whose level of education might not be like that of our study subjects who attended teaching hospital.

The prevalence of EBF in this study was 68.52% which was higher than 26% reported earlier from Kano, Nigeria, by Iliyasu et al. This could be due to increased awareness of EBF in this study of up to 77.8% compared to 31% reported by Iliyasu et al.[24] The finding in this study could also be due to educational level of the respondents where 91.79% of those with tertiary level of education had good knowledge on EBF. This is in keeping with the report that educated respondents were more than three times likely to practice EBF compared to their uneducated counterparts.[24] The prevalence of EBF in this study is also higher than 63% reported from Health and Statistical Service of Ghana.[25] The practice of EBF in this study is also higher than the findings of a study from rural communities in Osun, Southwestern Nigeria,[26] which had a prevalence of 20%. The high rate of EBF practice could be attributed to the level of educational attainment of mothers as reported by other studies.[21],[22],[27]

This study also found a positive correlation between good knowledge of EBF and practice of EBF among the respondents as 80.58% of those having good knowledge on EBF were found to practice it in this study. This is in keeping with other reports which confirmed the importance of mother's knowledge on breastfeeding and the practice of EBF.[27],[28],[29] This finding is also in consonance with other studies which showed that mother's knowledge about EBF is as good as having the practice done.[30] Other studies have also shown that mother's good knowledge on EBF is an important ingredient to successful EBF practice.[31]

This study found a positive correlation between acceptance of EBF and its practice among the respondents as 85.25% of those who accepted EBF were found to have practiced EBF. This may not be unrelated to the full understanding of EBF and its benefits among respondents. Practice of EBF was also observed to be high among respondents who lived in proximity to health facilities. This may be due to easy accessibility to the health facilities where information on antenatal and child care services are being provided.[1] Some studies have shown that home locations, mothers' literacy level, antenatal services, and occupation are really influencing EBF practices in Jos, Nigeria.[32]


  Conclusion Top


Many of the respondents had good knowledge, acceptance, and practice of EBF. Educational level, occupation, and mothers' location in relation to health facility had positive impact on knowledge, acceptance, and practice of EBF among caregivers in Kano. It is recommended therefore on the need to educate and empower women and make health facilities accessible to them to support, promote, and protect EBF in our communities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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